Chicago has a health outcome disparity problem. It’s a civic disgrace. Each year the consequence of this health equity gap in Chicago is that 3,200 black people die prematurely just because they do not have the same health outcomes as whites.
The reasons why these racial disparities in health outcomes persist in Chicago at levels greater than the rest of the country is a story unto itself. As Tolstoy wrote in Anna Karenina, “Happy families are all alike; every unhappy family is unhappy in its own way.” And Chicago’s racial disparity in health outcomes arises from our own unhappy history of race relations in the city. Chicago’s past has contributed to create the situation we have today: patterns of institutionalized racism, hypersegregated medically underserved neighborhoods, high rates of uninsurance and mistrustful attitudes towards the health care system.
The following figure from a recent Chicago Tribune article tells a story for breast cancer mortality disparity in Chicago that is instructive to review as we address solutions. A picture is worth a thousand words.
The line graph on a Chicago Tribune graphic (“Female Breast Cancer Mortality Rate by Race”) shows the growing breast cancer disparity gap in Chicago in three-year intervals from 1980 until 2007. There are three notable observations about this graph. First, in the 1980s there was virtually no difference in the black:white breast cancer mortality. Second, by 2007 breast cancer mortality was 62 percent higher in African American women than white women in Chicago. Third, while the mortality rates from breast cancer have dropped for white women as they should have with access to modern screening and treatment, the rates for black women in Chicago have not budged. It is as if all the newest developments in breast cancer screening and treatment have bypassed black women in Chicago.
The bar graph in the middle part of the figure (“Rate Disparity Between Black and White Women”) shows how unique this is to Chicago. The bar graph depicts the disparity gap in Chicago compared to that in the United States as a whole and New York City. The breast cancer mortality gap in Chicago is 50 percent higher than the United States as a whole and more than twice the New York City gap. Lastly, the map on the far right of the figure depicts the Chicago community areas with highest breast cancer mortality (almost all African American) and those Chicago hospitals with American College of Surgeons-approved cancer treatment programs. Of the 24 community areas with the highest breast cancer mortality in Chicago, only one has an approved cancer treating hospital within it.
The challenge to all of us in Chicago is not to dwell on the past or the facts. The challenge is how to fix it going forward.
One answer is the Chicago Breast Cancer Quality Consortium, which is a project of the Metropolitan Chicago Breast Cancer Task Force and the Illinois Hospital Association who have teamed together to standardize the quality of care at metropolitan Chicago hospitals that deliver breast care. This program, which has been funded by the Komen for the Cure Foundation, has many Chicago area institutions sharing data on the quality of screening and treatment with the goal of improving breast care for all women. I am proud to serve as president of the Metropolitan Chicago Breast Cancer Task Force, generously funded by the Avon Foundation, and I am on the steering committee for the Chicago Breast Cancer Quality Consortium.
Besides Rush University Medical Center and Rush Oak Park Hospital, there are 52 other area hospitals participating to eliminate this disparity by raising the quality of care for all women. And soon, this will be a statewide initiative as the state of Illinois will be expanding this quality initiative statewide.
Chicago’s legacy of racial disparity in breast cancer mortality can be overcome. The answer: quality breast care for all.
David Ansell, MD, MPH, is chief medical officer at Rush University Medical Center in Chicago.